Severe Vomiting in Pregnancy (Hyperemesis Gravidarum)

Nausea and vomiting, also known as morning sickness is a very common symptom of pregnancy and affects over 50% of pregnancies.

A woman might vomit more than 4 times a day starting between 4 and 10 weeks gestation and resolving at the end of the 16th week. It does not produce any health issues or restricts normal activities. You might lose some weight due to nausea and vomiting in the first 3 months and there is the availability of treatments to prevent it.

What is Hyperemesis Gravidarum?

Hyperemesis gravidarum is the severe type of vomiting of pregnancy that has got harmful effects on the health of the mother and affects her daily activities. It is an uncommon disorder affecting 0.3-3% of all pregnant women.

Persistent nausea and vomiting occur throughout the pregnancy, associated with dehydration, electrolyte imbalance and weight loss of up to 10% of the pre-pregnant weight.

It is not a fatal condition and starts to subside as the pregnancy advances or after the delivery of the baby.

What causes Hyperemesis Gravidarum?

The exact cause is unknown but the following are the known facts-

  • It is mostly limited to the first three months but can go beyond it.
  • It is related to the excess of the Human Chorionic Gonadotrophin (HCG) hormone of pregnancy. It is proved by the frequency of vomiting at the peak level of HCG.
  • It occurs most commonly in the first pregnancy but can recur again in subsequent pregnancies.
  • Those who have a family history of severe vomitings such as mother and sister also had it.
  • It is more prevalent in hydatidiform mole (abnormal condition of the placenta), multiple pregnancies (more than one fetus in the womb) and a woman with migraine headaches.
  • It is more common in unplanned pregnancies but less common among illegal cases.

What are the symptoms of Hyperemesis Gravidarum?

The symptoms can be grouped into early and late symptoms depending upon the severity of vomiting.

Early symptoms include

  • Nausea and vomiting occur throughout the day
  • Normal daily activities are affected
  • Weight loss up to 10% of pre pregnant weight
  • Presence of dizziness and faintness

Late symptoms include

  • Frequency of nausea and vomiting increases
  • Urine quantity decreases and constipation may occur
  • Epigastric pain due to increased frequency of vomiting
  • Presence of dehydration (features are sunken eyes, acetone smell in breath, increased heart rate, low blood pressure) and starvation.

How to diagnose Hyperemesis Gravidarum?

A healthcare professional may ask about the presence of vomiting symptoms; take medical, personal and obstetric history and perform a physical examination. The mother may undergo other tests such as urine tests, blood tests, ultrasonography (to confirm the pregnancy and to identify any other existing medical condition).

How is Hyperemesis Gravidarum treated?

Treatment of the woman with severe vomiting depends upon the severity of symptoms. The principles to be followed while treating a woman with vomiting-

  • To control the vomiting
  • To correct fluid and electrolyte imbalances
  • To prevent or detect any complication that may arise.

Treatment might include-

  • Hospitalization– A woman with severe nausea and vomiting throughout the day with dehydration might require hospitalization to maintain normal fluid and electrolyte balance by giving IV fluids.
  • IV fluids– Oral feeding is withheld in the woman with severe vomiting. During this time, IV fluids are given through intravenous route approx 3 litres in 24 hrs to treat dehydration and fluid and electrolyte imbalances.
  • Medicines- Medicines are given to control, stop and prevent nausea and vomiting.
    • Anti-emetic medicines such as promethazine, stemetil or siquil may be administered to prevent vomiting
    • Hydrocortisone may be administered with IV fluids in case of hypotension
    • Nutritional supplements with vitamins(B1, B6, B12 and Vit C) are given.
  • Diet- If the woman can take fluids by mouth then IV fluids are discontinued and foods are given orally with fluids.
    • At first, dry foods such as biscuits, toast, bread and crackers are given
    • A small and frequent diet 4 to 5 times a day is effective
    • Avoid spicy, oily and fatty foods
    • Consume a bland diet.
  • Rest– The mother is encouraged to take complete rest.

If hyperemesis is left untreated, the mother’s condition worsens. Wernicke’s encephalopathy is a complication associated with a lack of vitamin B1(thiamine) may arise.


In the above post, we discussed severe nausea and vomiting(hyperemesis gravidarum) in pregnancy, its causes, symptoms, diagnosis and treatment.

Thank you!!! Hope you find this useful.

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